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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 1039-1047, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
GS Kopf, CS Kleinman, ZM Hijazi, JT Fahey, ML Dewar and WE Hellenbrand
Ten patients, each with two or more risk factors for morbidity and death,
underwent a fenestrated Fontan procedure in which a 4 to 6 mm circular
fenestration was left between the systemic and pulmonary venous chambers.
None died; a similar group of high-risk patients without fenestration had a
mortality rate of 2 of 8. Patients with fenestration had significantly less
drainage from the chest tube, less need for inotropic support, and shorter
intensive care and hospital stays than did patients without fenestration.
Comparison with a group of low-risk patients undergoing the Fontan
operation showed no statistical difference in these postoperative
parameters. Fenestrations were closed in all 10 patients at from 9 days to
6 months after operation by means of the transcatheter clamshell occluder
device. Two patients had left pulmonary artery balloon angioplasty and
three patients had other atrial communications closed with additional
clamshell devices. During short-term follow-up periods averaging 18 months,
all patients were clinically well; however, one patient with mitral atresia
required reoperation for obstruction between the left atrium and the
tricuspid valve, not related to the clamshell device. These data indicate
that fenestration may be one method of achieving lower morbidity and
mortality rates among high-risk patients undergoing the Fontan procedure.
ARTICLES
Fenestrated Fontan operation with delayed transcatheter closure of atrial septal defect. Improved results in high-risk patients
Department of Surgery, Yale University School of Medicine, New Haven, CT 06510.
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